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Effectiveness of key indicators as instrument in detecting risks in healthcare Ine Borghans

Effectiveness of key indicators as instrument in detecting risks in healthcare Ine Borghans. Methods of Supervision. Risk Indicators. Thematic. Quality system. Suspicions criminal offenses. Incidences. Methods of Supervision. Risk Indicators. Thematic. Quality system.

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Effectiveness of key indicators as instrument in detecting risks in healthcare Ine Borghans

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  1. Effectiveness of key indicatorsas instrument in detecting risks in healthcare Ine Borghans

  2. Methods of Supervision Risk Indicators Thematic Quality system Suspicionscriminaloffenses Incidences

  3. Methods of Supervision Risk Indicators Thematic Quality system Suspicionscriminaloffenses Incidences

  4. Risk indicators Used in ‘Risk-based' supervision To render the risk of healthcare services measurable and transparent. Developed in cooperationwith the health care providers.

  5. Canary indicator of the coal mine

  6. Hospital adverse events often result in a longer length of stay(seereferencesonnextslide)We developed a new indicator that uses the unexpectedly long length of stay (UL-LOS) as a potential risk factor for unsafe care.

  7. References Hoonhout LH, de Bruijne MC, Wagner C, Asscheman H, van der Wal G, van Tulder MW. Nature, occurrence and consequences of medication-relatedadverseeventsduringhospitalization: a retrospectivechartreview in the Netherlands. Drug Saf. 2010 10/01;33(10):853-64. Hoonhout LH, de Bruijne MC, Wagner C, Zegers M, Waaijman R, Spreeuwenberg P, et al. Direct medicalcosts of adverseevents in Dutch hospitals. BMC Health Serv.Res. 2009;9:27. Sari AB, Sheldon TA, Cracknell A, Turnbull A, Dobson Y, Grant C, et al. Extent, nature and consequences of adverseevents: results of a retrospectivecasenotereview in a large NHS hospital. Qual.Saf Health Care 2007 12;16(6):434-9. Ehsani JP, Jackson T, Duckett SJ. The incidence and cost of adverseevents in Victorianhospitals 2003-04. Med.J.Aust. 2006 06/05;184(11):551-5. Cho SH, Ketefian S, Barkauskas VH, Smith DG. The effects of nurse staffingonadverseevents, morbidity, mortality, and medicalcosts. Nurs.Res. 2003 03;52(2):71-9. Camp M, Chang DC, Zhang Y, Chrouser K, Colombani PM, Abdullah F. Risk factors and outcomesforforeign body leftduring a procedure: analysis of 413 incidentsafter 1 946 831 operations in children. Arch.Surg. 2010 11;145(11):1085-90. Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS, et al. Factors associatedwithcomplications in olderadultswithisolatedbluntchest trauma. West J.Emerg.Med. 2009 05;10(2):79-84. Williams DJ, Olsen S, Crichton W, Witte K, Flin R, Ingram J, et al. Detection of adverseevents in a Scottishhospitalusing a consensus-basedmethodology. Scott.Med.J. 2008 11;53(4):26-30. Kaushal R, Bates DW, Franz C, Soukup JR, Rothschild JM. Costs of adverseevents in intensive care units. Crit.CareMed. 2007 11;35(11):2479-83. Rice-Townsend S, Hall M, Jenkins KJ, Roberson DW, Rangel SJ. Analysis of adverseevents in pediatricsurgeryusing criteria validatedfrom the adultpopulation: justifying the needforpediatric-focusedoutcomemeasures. J.Pediatr.Surg. 2010 06;45(6):1126-36. Schioler T, Lipczak H, Pedersen BL, Mogensen TS, Bech KB, Stockmarr A, et al. Incidence of adverseevents in hospitals. A retrospectivestudy of medical records. Ugeskr.Laeger 2001 Sep 24;163(39):5370-8. Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian AdverseEventsStudy: the incidence of adverseeventsamonghospitalpatients in Canada. CMAJ 2004 May 25;170(11):1678-86. Davis P, Lay-Yee R, Briant R, Ali W, Scott A, Schug S. Adverse events in New Zealand public hospitals I: occurrence and impact. N.Z.Med.J. 2002 Dec 13;115(1167):U271.

  8. Indicator: Percentage of patientswithanunexpectedly long length of stay (UL-LOS) Methods: • Based on a prolonged length of stay of more than 50% • Standardisation for patients’ age, primary diagnosis and main procedure • Three strata of hospitals: • 31 general hospitals • 24 tertiary teaching hospitals • 8 university medical centres

  9. Why based on a prolonged length of stayof more than 50%? • to include patients that stayed longer because of complications and adverse events • and not patients that just stayed a little bit longer because of variations in the treatment, such as in logistics

  10. Example - patient of 18 yearsold - appendicitis - appendectomy Expected LOS 3,4 dagen 3,4 + 1,7 = 5,1 days Actual LOS 6 daysor more: UL-LOS

  11. Results

  12. How does the Inspectorateusethis indicator? Most important problem: hospitals without UL-LOS percentage Otherhospitals: High percentage is an important signal Inspectorsask to inspectdetailedinformation per specialism Patientswith UL-LOS: record reviewing to learnwhat went wrong

  13. PRO’s and CON’s of workingwithonekey indicator Pro: Les administrativeburdenforcaregivers Mucheasierfor the inspector Contra: High demandsregarding to thisspecific indicator: validity reliability comparability Outcomes are notcompensatedbyother indicators!

  14. Canary indicator of the coal mine

  15. Aviation: dashboard withsomekey indicators

  16. 3 Indicators whichmayreveal risk of unsafe care

  17. Thanksforyourattention!

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